A narrative review highlights the importance of recognizing “borderline resectable colorectal liver metastases” (br-crlm) as a distinct entity. By analyzing criteria for resectability, researchers found a significant need for chemotherapy prior to surgery. Advances in surgical techniques, locoregional therapies, and perioperative chemotherapy have improved long-term survival outcomes for patients with br-crlm undergoing treatment. The current […]
Category: HPB & Spleen
Robotic liver surgery shows manageable learning curves for surgeons
Evaluation of robotic liver resections at San Raffaele Hospital revealed effective learning curves for two surgeons with varied laparoscopic experience. The pioneer surgeon achieved proficiency in high-complexity cases after 10 cases, while the new generation surgeon required 18. Operative times improved significantly for both after completing 15 low and 10 intermediate cases, demonstrating the impact […]
Better IPMN risk stratification could optimize cancer surgery decisions.
Personalized Cancer Risk Thresholds Can Guide IPMN Surgery Decisions Clinicians found that optimal cancer risk thresholds (CRT) for surgery in patients with branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) vary based on age, comorbidities, and tumor location. For a 60-year-old with mild comorbidities, surgery was favored at a 20% CRT for tumors in the pancreatic head […]
Alloplastic grafts enhance patency in pancreatic surgery
Findings reveal that alloplastic vascular grafts used in pancreatic surgeries demonstrate superior patency rates compared to other materials. For example, the 7-day patency rate reached 99%, while the 1-year patency for polytetrafluorethylene grafts was 78%. Among 201 patients, the all-cause 90-day mortality was recorded at 10%, with no incidences of graft infection. The study highlights […]
Same-day discharge after hepatectomy is safe for low-risk patients
Analysis of 7,279 patients undergoing laparoscopic or robotic hepatectomy revealed that same-day discharge is feasible for low-risk individuals. Among 361 patients discharged on the same day, there were no significant differences in 30-day mortality, readmissions, or postoperative complications compared to admitted patients. Younger age and fewer comorbidities characterized the same-day discharge cohort, suggesting careful patient […]
A standardized approach for hepatobiliary anastomotic leakage is needed.
A narrative review highlights the absence of a universally accepted definition and grading system for anastomotic leaks (AL) in hepato-pancreato-biliary procedures. Variability in reported incidence complicates understanding and managing complications such as postoperative pancreatic fistula and bile leaks. The review emphasizes the substantial human and economic costs associated with AL, including increased morbidity, mortality, and […]
Primary tumor resection significantly enhances survival in liver metastases
Analyzing data from 21,928 patients, researchers determined that primary tumor resection (PTR) improves overall and cancer-specific survival rates for patients with colorectal, pancreatic, and breast cancer liver metastases. Significant factors influencing survival benefits from PTR included age and tumor characteristics for colorectal patients, while chemotherapy affected pancreatic cancer outcomes. Additionally, a predictive model was developed […]
Spontaneous portosystemic shunts predict post-hepatectomy liver failure
Analysis of pre-operative CT scans indicated that spontaneous portosystemic shunts (SPSs) were present in 17.4% of patients undergoing liver resection for hepatocellular carcinoma. Among 425 patients, post-hepatectomy liver failure (PHLF) occurred in 6.4%, with 4% experiencing grades B/C. Multivariable analysis revealed SPS as an independent risk factor for all-grades PHLF (OR 6.83) and clinically significant […]
Inadequate surgical management of gallbladder cancer impacts survival.
Gallbladder cancer patients who received oncological resection demonstrated significantly better overall survival rates compared to those undergoing cholecystectomy alone. Among 1,129 patients analyzed, 299 had complete resection, with survival rates at one, three, and five years markedly higher for these patients. Factors influencing inadequate surgical intervention included female gender, advanced age, frailty, treatment by general […]
Combined prognostic model outperforms individual models for PDAC survival
A combined prognostic model integrating deep learning-derived digital pathology features and clinical indicators demonstrated enhanced predictive accuracy for pancreatic ductal adenocarcinoma (PDAC) survival. In a study involving 142 postoperative cases, the combined model achieved a Harrell concordance index (c-index) of 0.86 in the training set and 0.77 in the testing set, surpassing the individual clinical […]